Coordinated Aboriginal mental health care: A best practice model

Coordinated Aboriginal mental health care: A best practice model for rural and metropolitan service delivery

The aim of the Coordinated Aboriginal Mental Health Care (CAMHC) project was to develop, implement and evaluate agreed protocols and pathways for care of Aboriginal people and their families affected by mental health (MH) including alcohol and other drug (AOD) issues, often in the context of multiple health and social challenges.

This project responded to recommendations from the project team's previous research, and requests from the Aboriginal community in the Eyre Peninsula region of South Australia. It was also part of the team's larger program of work directed at assisting Aboriginal people affected by MH/AOD issues and coexisting physical illnesses. An action-oriented research approach was used. Decisions about implementing identified strategies were driven by participating health services' priorities and capacities.

Achievements associated with the project included:

• Development of a uniform MH/AOD screening, assessment and referral system for all Pt Lincoln Aboriginal Health Service (PLAHS) clients 
• Staff education in relation to MH/AOD, eg duty of care, confidentiality, and client information management
• New positions and collaborative work arrangements at PLAHS to support coordinated MH/AOD case management, eg clinical coordinator, team care for clients with complex needs
• Inter-agency training in response to shared needs, eg co-morbidity, emergency MH/AOD care
• Advocacy and successful lobbying for better MH/AOD services and policies, eg after hours telephone help regarding MH/AOD problems, extended hours for sobering up unit and mobile assistance patrol in Ceduna, and more Aboriginal input into review of MH legislation in SA
• Interagency linkages and agreements.

Research actions included:

• Identification of barriers and enablers of coordinated care through semi-structured interviews with a wide range of health and human service providers and policy makers involved in assisting Aboriginal people with MH/AOD isues and a review of the literature
• Development and implementation of new strategies for improvement with the health services involved. Some strategies have been implemented directly by the team and with project support, while in other cases the project team advocated successfully or faciliated the necessary linkage or change
• Evaluation, reflection and reporting on the processes and impacts of the project.

In 2009 the project team boosted its research transfer activities, informing a wide range of peak Aboriginal health bodies and community leaders, and key service providers, policymakers and program funders, about the project findings and the strategies that the research team have been developing and trialling. The project team facilitated agreement of key stakeholders to implement the IRIS (Indigenous Risk Impact Screen) as part of a system-wide, consistent approach to providing best practice coordinated Aboriginal MH/AOD care in South Australia.

Key findings:

• The document review showed intense need and willingness to improve coordination of Aboriginal health care, but there is little evidence that existing policies and protocols are followed or effective.
• Interviews with Aboriginal health service providers and Aboriginal community leaders highlighted their dedication and commitment to improving Aboriginal health, and their resilience, skills and achievements, often despite difficult circumstances.
• The Aboriginal and mainstream health workforce is hungry for knowledge, skills, resources and tools to assist them in providing best-practice coordinated MH/AOD care for Aboriginal people. Similarly, Aboriginal community members want to know more about MH/AOD and other health issues and what they can do to manage their own health. Many of these 'capacity development' needs were addressed successfully during the project.
• Service providers want to provide quality holistic care, and understand that this requires new ways of working and organisational changes that can be challenging and protracted. Participating services made significant progress towards this goal during the project, aided by steady leadership and broad support within the services and community.

A systematised approach to delivering best practice Aboriginal MH/AOD care across all levels of the health system (Aboriginal and mainstream) must be implemented as a matter of urgency. Key steps include:

• Helping Aboriginal health services to re-orient their service delivery arrangements to provide holistic, client-centred, 'no wrong door' primary health care.
• Implementing a uniform triage, assessment, early intervention and referral tool and process within Aboriginal and other health/human services.
• Embedding these tools in the electronic patient information and recall system.
• Ensuring that all staff routinely access and document information in the electronic patient information and recall system, to enable appropriate opportunistic care, follow-up on care plans and referrals.
• Developing simple information sharing systems and protocols between services, underpinned by service agreements.
• Ensuring that quality, comprehensive data is captured and reported by services to demonstrate activity and outcomes and increase funding streams.
• Continuing to offer interagency training and resources to the workforce around shared needs, and education and resources for the community, to promote shared care.

Partners involved: Flinders University, Port Lincoln Aboriginal Health Service (PLAHS), Ceduna–Koonibba Aboriginal Health Service (CKAHS), University of Adelaide, Eyre Peninsula Division of General Practice

Related resources:

• Ah Kit, J., Miller, H., de Crespigny, C., Murray, H., Kowanko, I., Prideaux, C., Mills, D. & Emden, C. 2010, Coordinated Aboriginal Mental Health. Celebrating the successes and achievements at PLAHS and telling the 10 year story of participatory action research.
• Kowanko, I., de Crespigny, C., Murray, H., Ah Kit, J., Prideaux, C., Miller, H., Mills, D. & Emden, C. 2009, 'Improving coordination of care for Aboriginal people with mental health, alcohol and drug use problems - progress report on an ongoing collaborative action research project', Australian Journal of Primary Health, vol. 15, no. 4, pp. 341–7.
• Kowanko, I., Prideaux, C., Ah Kit, J., Ordasi, L., Murray, H. & de Crespigny, C., 2007, 'Rural and Remote Aboriginal Mental Health – Meeting the Challenges', in P. Hanlon, S. Robertson, K. Kellerhear, et al. (eds), Reach Out: Connect. Contemporary TheMHS in mental health services, TheMHS Conference Inc, Balmain Australia, pp220-227 (refereed, full conference paper)
• de Crespigny, C., Kowanko, I., Murray, H., Wilson, S. & Ah Kit, J. 2006, 'A nursing partnership for better outcomes in Aboriginal alcohol, other drugs and mental health', Contemporary Nurse, vol. 22, no. 2, p. 275.
• Kowanko, I. 2005, 'Coordinated Aboriginal mental health care—A model for best practice', Indigenous Health Matters, vol. 12 (June), p. 8.
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